Internal Medicine Billing Services | TCM, CCM, AWV Specialists | Quilven RCM
Home/Specialties/Internal Medicine
Specialty · Internal Medicine

The money is in the followup.

Most IM revenue does not come from the visit. It comes from what happens around it. The hospital discharge that needs a TCM coded within fourteen days. The CCM minutes nobody logged. The 99215 that got billed as a 99214 because reading the note takes time. We work the followup.

Request the 48 hour audit → See the math →
0days
Target time to billable for a new IM provider
0%
Clean claim rate target
0hrs
Free audit turnaround
The vendor gap in internal medicine

If your billing company is paid 5% of what they collect, do the math.

A typical billing vendor takes five to eight percent of collections. On a clean 99214 they earn seven to ten dollars. On a 99496 they earn fourteen to twenty two. On a 99490 they earn under four. That math drives every decision they make about which claims to chase, which denials to appeal, and which functions to walk away from.

TCM is the obvious casualty. The hospital faxes the discharge summary on Friday. By Tuesday it is sitting in a queue. The patient calls for a followup, the front desk schedules a regular office visit, and three weeks later someone bills it as a 99213. The 99496 window closed on day seven. The 99495 window closed on day fourteen. The revenue is gone and nobody on your billing team is going to mention it because they were not paid to notice.

Same with CCM. The patient has diabetes and hypertension and is sixty eight. They are eligible. The barrier is operational. Somebody has to get the written consent, build the care plan in the EHR, log the twenty minutes a month, and bill 99490. Per patient per month it is sixty dollars. Across two hundred enrolled patients it is one hundred forty four thousand dollars a year. Vendors that quote a percentage do not run CCM programs. The hours do not pencil out for them.

We are structured the other way. The department gets paid to own the cycle, not to skim it.

The leak, in numbers

Three sliders. Watch the followup revenue.

Pull these numbers from any practice management report. The output is what your panel should be generating in TCM, CCM, and stacked AWVs that most IM practices currently leave on the table.

Active panel size
3,500
10015,000
% of panel discharged per year
12%
2%30%
% eligible for CCM (2+ chronic conditions)
35%
10%70%
% Medicare in panel
55%
20%90%
TCM revenue
99495 plus 99496 on qualifying hospital discharges
$0
CCM revenue
99490 plus 99439 across enrolled CCM patients
$0
AWV revenue
G0438 first year, G0439 every year after, on the Medicare cohort
$0
Annual recoverable
$0

Based on CMS national average rates. Your real number is usually larger once you add the downcoded 99214s, the missed modifier 25 stacks on AWV plus problem visits, and the patient responsibility your front desk never collected. The 48 hour audit gives you the line by line breakdown from your own data.

Side by side

Same IM practice. Two outcomes.

What a percentage based billing vendor delivers for an internal medicine practice versus what a managed department delivers. The economics drive the work.

Typical billing vendor

Paid for claims submitted. Not collected.

  • E/M coding accepts the EHR default. A 99215 visit goes out as a 99214 and nobody flags it.
  • Hospital discharges never enter the billing workflow. TCM windows close before the claim is built.
  • CCM is out of scope. The recurring revenue line item never starts.
  • AWV gets billed once. Stacking a same day problem visit with modifier 25 happens inconsistently.
  • First denial appeal gets sent. Second appeal does not because the math does not work for them.
  • Aged AR over ninety days goes quiet, then gets written off when nobody checks.
  • Credentialing is opaque. Status is "in progress" for one hundred and eighty days.
  • Monthly PDF shows what was paid. Nothing shows what was missed.
Quilven · Department model

Paid to own the whole cycle.

  • Certified coder reviews documentation before submission. 99215s stay 99215s when the note supports it.
  • Hospital discharge feeds get routed into the workflow on day one. TCM gets scheduled inside the seven day window.
  • CCM program stood up. Eligible patients identified, consent collected, time logged, billed monthly.
  • AWV with modifier 25 stacked on the same day E/M when documentation supports it. About eighty dollars per qualifying encounter, not skipped.
  • Denials worked to round three or four when the dollar amount and clinical merit support it.
  • AR over ninety days is the first queue our analysts open in the morning, not the last.
  • Credentialing is a live master sheet your team can see. Weekly payer followups. Target ninety days to billable.
  • Apex dashboard shows what was paid and what was missed. Weekly summary, live data, no PDF.
CPT and HCPCS reference

Every code that pays internal medicine.

Sixty plus codes in IM scope. Search by number or filter by category. Each card has the fee range, what the code bills for, the denial patterns we see most, and what we look for in the note.

Pick a code above or search by number.
What we cover

Eight functions of IM revenue cycle, under one team.

A managed department, not a claim submission service. Every function below runs under the same operations head, with the same KPIs, reporting into Apex.

Function What Quilven runs What typical vendors do
E/M coding accuracy Certified coder reviews documentation. 99214 versus 99215 calls made against the note, not by template default. Distribution audited monthly. Submits whatever the provider clicked. Downcoding stays invisible.
Transitional Care Management Hospital discharge feeds connected. Patient scheduled inside the seven day window. 99495 and 99496 billed with proper documentation linkage. Not in workflow. Post discharge visits go out as regular 99213 or 99214.
Chronic Care Management Eligible patients identified from the panel. Consent and care plan workflow set up. Monthly billing of 99490 and 99439 with logged time. Out of scope. The recurring revenue never starts.
Advance Care Planning 99497 and 99498 captured when the conversation happens. Documentation prompts in the EHR. The conversation gets written into the visit narrative and never makes it onto the claim.
AWV optimization G0438 and G0439 billed correctly. Same day problem visit stacked with modifier 25 when documentation supports it. AWV billed alone. The stacked E/M gets denied or skipped.
Aged AR recovery Claims over ninety days worked first in the queue. Appeal level two and three pursued when the math justifies it. Aged claims written off. First appeal sent. Second is uneconomic at five percent.
Credentialing CAQH maintained. PECOS revalidations on calendar. Live master sheet. Target ninety days to billable for new providers. Status updates by email when asked. Average one hundred twenty to one hundred eighty days.
Reporting and analytics Apex dashboard. Net collection rate, days in AR, denial trends, CCM enrollment, all live. Weekly summary call. Monthly PDF. Shows what was paid. Shows nothing about what was missed.
2 minute self audit

How much is your IM cycle actually leaking?

Eight questions. No email required. The result is written for IM, with the specific line items leaking based on your answers.

Question 01 of 08
Common questions

Internal medicine billing, answered straight.

The questions practice administrators actually ask before signing with a billing company.

The best billing service for an internal medicine practice is one structured to capture the followup revenue that drives IM economics. That means transitional care management within the seven and fourteen day windows after hospital discharge, monthly chronic care management billing for eligible Medicare patients, annual wellness visits stacked with same day problem visits using modifier 25, and E/M coding reviewed against the actual documentation rather than the EHR default. Quilven runs all of these as a managed department, not a percentage of collections billing service.
Typical internal medicine billing vendors charge 5 to 8 percent of collections. The problem with that model is the math. On a 99490 chronic care management claim that pays sixty two dollars, the vendor earns under four dollars. The work to run a CCM program is not worth four dollars to them, so they do not run it. Quilven uses a managed department pricing model that includes the unpaid functions percentage based vendors skip.
Internal medicine bills primarily evaluation and management codes (99202 through 99215 for new and established office visits), transitional care management codes (99495 moderate complexity, 99496 high complexity), chronic care management codes (99490, 99439, 99491, 99437, 99487, 99489), principal care management (99424 through 99427), annual wellness visit codes (G0402 welcome to Medicare, G0438 initial, G0439 subsequent), advance care planning (99497, 99498), behavioral health integration (99484), psychiatric collaborative care (99492 through 99494), remote patient monitoring (99453, 99454, 99457, 99458), preventive screenings (G0444 depression, G0442 alcohol), tobacco cessation (99406, 99407), prolonged services (99417, G2212), vaccine administration (90471, 90472, G0008, G0009), and in office labs and procedures.
Transitional care management in internal medicine is the billing of post discharge care under CPT codes 99495 and 99496. The patient transitions from a hospital, observation stay, or skilled nursing facility back to community care. Interactive contact is required within two business days of discharge. A face to face visit is required within fourteen calendar days for 99495 (moderate complexity, pays roughly two hundred dollars) or within seven calendar days for 99496 (high complexity, pays roughly two hundred eighty dollars). Most IM practices miss TCM because the hospital discharge does not flow into the billing workflow. The visit happens, but it gets coded as a regular 99213 or 99214 instead of TCM.
Chronic care management billing requires written patient consent, two or more chronic conditions expected to last twelve plus months, a documented care plan in the EHR, at least twenty minutes of clinical staff time per calendar month directed by a physician, and twenty four seven access to care. 99490 covers the first twenty minutes per month and pays approximately sixty two dollars. 99439 is the add on for each additional twenty minutes, up to twice per month. 99491 covers thirty minutes of physician personal time and pays approximately eighty four dollars. For complex CCM with moderate or high complexity decision making, use 99487 (sixty minutes) and 99489 (each additional thirty minutes). The structural challenge is operational, not clinical. Eligibility on an internal medicine panel is usually thirty to forty percent of patients.
Yes. An annual wellness visit (G0438 initial or G0439 subsequent) can be billed on the same day as a problem oriented E/M visit (such as 99214) when both services are documented separately. Modifier 25 must be appended to the E/M code to identify it as significant and separately identifiable from the AWV. Without modifier 25, the E/M will be denied as bundled. Done correctly, the same day stack adds approximately eighty dollars per qualifying encounter. Most internal medicine practices either skip the stack entirely or apply modifier 25 inconsistently across coders.
Industry average for internal medicine provider credentialing is one hundred twenty to one hundred eighty days from start to billable. Vendors that treat credentialing as a side task often run longer. Quilven targets ninety days to billable through a live master sheet visible to the practice, weekly payer follow ups, dedicated enrollment leads on CAQH and PECOS, and proactive revalidation tracking. Every month a new internal medicine provider is not billable costs the practice approximately thirty five thousand to fifty thousand dollars in lost revenue.
Quilven offers a free 48 hour billing audit with no commitment for internal medicine practices and other physician specialties. The practice sends ninety days of claims data. Within 48 hours, Quilven returns a line by line breakdown showing what is recoverable by CPT code, by payer, and by month. Common findings include 99214 visits downcoded as 99213, TCM windows missed, CCM eligible patients never enrolled, AWV plus E/M stacks unbilled, and aged AR written off prematurely. The audit is delivered as a PDF report and a thirty minute review call. The practice keeps the findings whether or not they engage Quilven for managed RCM services.
Quilven is headquartered in Nashville, Tennessee. The company serves internal medicine practices, primary care groups, behavioral health practices, and community hospitals across the United States. All work is performed by HIPAA compliant staff with business associate agreements in place. Practices can be on any EHR including eClinicalWorks, NextGen, AdvancedMD, Athenahealth, Epic, Cerner, Practice Fusion, or Greenway.
Typical medical billing companies are paid five to eight percent of collections. That economic model means they prioritize easy claims, write off aged AR, and skip unpaid functions like chronic care management setup, denial appeals beyond round one, and credentialing follow up. Quilven operates as a managed department, with a flat operational model that includes the work percentage vendors skip. Practices get certified coder review on E/M, TCM workflow integration with hospital discharge feeds, CCM program setup and monthly billing, AWV plus E/M stacking with proper modifier 25 handling, denial recovery to round three or four when the dollar amount supports it, aged AR worked first in the morning queue, and live dashboard reporting through the Quilven Apex platform.
About Quilven

The billing department for internal medicine.

Quilven is a managed revenue cycle management company based in Nashville, Tennessee. We provide end to end medical billing services for internal medicine practices, primary care groups, behavioral health practices, and community hospitals across the United States.

The company runs a managed department model rather than a percentage of collections billing service. The structural reason matters. Vendors paid five to eight percent of collections optimize for high dollar, easy to clear claims. They skip the work that does not pay them, which in internal medicine is most of the followup revenue. That includes transitional care management after hospital discharge, chronic care management for eligible Medicare patients, annual wellness visit stacking with modifier 25, denial recovery beyond round one, and aged AR over ninety days.

Internal medicine billing under the Quilven model includes certified coder review on E/M coding (99202 through 99215), hospital discharge feeds integrated into the workflow for TCM capture inside the seven and fourteen day windows, CCM program setup with consent collection and time tracking, AWV optimization for the Medicare cohort, denial appeals to round three or four when the dollar amount and clinical merit support it, aged AR worked first thing in the morning, and provider credentialing managed against a target of ninety days to billable.

The company is HIPAA compliant. Business Associate Agreements are available on request. Quilven works with practices on any EHR platform including eClinicalWorks, NextGen, AdvancedMD, Athenahealth, Epic, Cerner, Greenway, and Practice Fusion.

Other specialty billing services
Specialty
Primary Care billing
→ E/M, AWV, CCM, preventive
Specialty
Behavioral Health billing
→ CoCM, BHI, parity, telehealth
All specialties
View all specialty pages
→ Cardiology, OB/GYN, Ortho
Free · No commitment

Send us ninety days of claims. We send back what is recoverable.

Line by line, by code, by payer, by month. If your cycle is clean you get outside confirmation. If it is leaking you get a real number from your own data, not an industry average.

Request the 48 hour audit → Back to Quilven →